Characterizing social vulnerability is fundamental to disaster response planning. Numerous vulnerability indicators have been developed, but they are typically not validated for their predictive power over the outcomes of interest. As with many environmental health studies where interventions are impractical or unethical, validation of social vulnerability against public health outcomes is observational and relies on spatially-dependent data. Observational studies are susceptible to bias induced by unmeasured confounders. This problem is exacerbated in spatial studies with multiple health outcomes and environmental exposure variables, as the source and magnitude of confounding bias may differ by spatial scale and across exposure/outcome pairs. We propose to mitigate confounding effects in multivariate spatial studies using a tensor-regression model that allows exposure effects to vary by exposure, outcome, and spatial scale. By extracting exposure effects that correspond to local spatial scales, we replace the strict causal assumption of no unmeasured confounders with a more realistic assumption of local unconfoundedness i.e., differences between nearby regions are unconfounded, allowing for causal interpretation. Our study of the Southern United States shows that economic resilience (Theme 1) demonstrates the strongest positive effect on diabetes and negative effect on hyperlipidemia. Our analysis reveals a concise representation of the effects of social vulnerability indices on an array of chronic health outcomes, offering interpretable epidemiological insights that adjust for multivariate spatial confounding.

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